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Geagea V, Echtay L, Salman F, Ghaname W, Ziadeh H. Isolated torsion of the fallopian tube associated with hematosalpinx in a 17-year-old adolescent: A case report. Int J Gynaecol Obstet 2024; 165:382-383. [PMID: 38112290 DOI: 10.1002/ijgo.15289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 11/20/2023] [Accepted: 11/22/2023] [Indexed: 12/21/2023]
Affiliation(s)
- Vanessa Geagea
- Department of Obstetrics and Gynecology, Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Leen Echtay
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Firas Salman
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Wadih Ghaname
- Department of Obstetrics and Gynecology, Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Hanane Ziadeh
- Department of Obstetrics and Gynecology, Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
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El Hayek P, Chlala W, Younes K, Ghaname W, Ziadeh H. Severe hemoperitoneum from spontaneous rupture of uterine tumor resembling ovarian sex-cord tumor: A very rare case. Int J Gynaecol Obstet 2024; 164:355-357. [PMID: 37743788 DOI: 10.1002/ijgo.15151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 08/26/2023] [Accepted: 09/10/2023] [Indexed: 09/26/2023]
Abstract
SynopsisA case of uterine tumor resembling ovarian sex‐cord tumor with an unfamiliar presentation. Management was performed based on the clinical findings and the literature recommendations.
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Affiliation(s)
- Pamela El Hayek
- Department of Obstetrics and Gynecology, Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Walid Chlala
- Department of Obstetrics and Gynecology, Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Kenny Younes
- Department of General Surgery, Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Wadih Ghaname
- Department of Obstetrics and Gynecology, Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Hanane Ziadeh
- Department of Obstetrics and Gynecology, Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
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Farah S, Hijazi M, Aoun E, Boueri M, Nasr E, Chlala W, Salem MJ, Moufawad G, Farah D, El Hayek P, Jallad K, Ghaname W, Ziadeh H. Effect of COVID-19 vaccinations on menstrual cycle and postmenopausal bleeding among health care workers: A cross-sectional study. Int J Gynaecol Obstet 2023. [PMID: 37132636 DOI: 10.1002/ijgo.14809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 03/27/2023] [Accepted: 04/12/2023] [Indexed: 05/04/2023]
Abstract
OBJECTIVE To determine the effect of coronavirus disease 2019 (COVID-19) vaccination and its association with sociodemographic factors on the menstrual cycle in premenopausal women and on postmenopausal bleeding. METHODS This is a retrospective cross-sectional study conducted between September 22, 2022, and November 30, 2022, via a questionnaire distributed to 359 health care workers (HCWs) at Lebanese American University Medical Center-Rizk Hospital and St John's Hospital. Inclusion criteria included female Lebanese HCWs who were vaccinated and aged 18 to 65 years. RESULTS Change in cycle length was significantly associated with age (P = 0.025 after the first dose and P = 0.017 after the second dose), level of education (P = 0.013 after the first dose and P = 0.012 after the second dose), and fibroids (P = 0.006 after the second dose and P = 0.003 after the third dose). The change in cycle flow was significantly associated with age (P = 0.028), fibroids (P = 0.002 after the second dose and P = 0.002 after the third dose), bleeding disorders (P = 0.000), and chronic medications (P = 0.007). The change in symptoms was associated with polycystic ovary syndrome (P = 0.021), chronic medications (P = 0.019 after the second dose and P = 0.045 after the third dose), and fibroids (P = 0.000). CONCLUSION COVID-19 vaccination can influence the menstrual cycle. Age, body mass index, level of education, underlying comorbidities, and use of chronic medications are significantly associated with changes in menstrual length, flow, and symptoms following vaccination.
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Affiliation(s)
- Stephanie Farah
- Department of Research, Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Mariam Hijazi
- Department of Research, Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Eliane Aoun
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Myriam Boueri
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Elena Nasr
- Department of Obstetrics and Gynecology, Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Walid Chlala
- Department of Obstetrics and Gynecology, Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Marie Josee Salem
- Department of Obstetrics and Gynecology, Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Graziella Moufawad
- Department of Obstetrics and Gynecology, Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Dany Farah
- Department of Research, University of Sainte Famille, Batroun, Lebanon
| | - Pamela El Hayek
- Department of Research, Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Karl Jallad
- Department of Obstetrics and Gynecology, Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Wadih Ghaname
- Department of Obstetrics and Gynecology, Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Hanane Ziadeh
- Department of Obstetrics and Gynecology, Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
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Ziadeh H, Duforestel T, Bouredji K, Re D, Debono L, Zreik T, Moufawad G, Ghaname W. The evolution of mature cystic teratomas of the ovary into squamous cell carcinoma: two case reports and review of the literature. J OBSTET GYNAECOL 2022; 42:838-841. [DOI: 10.1080/01443615.2022.2035333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Hanane Ziadeh
- Department of Obstetrics and Gynecology, Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University Medical Center, Beirut, Lebanon
| | - Thierry Duforestel
- Department of Obstetrics and Gynecology, Antibes Juan – Les – Pins Hospital Center, Antibes, France
| | - Kenza Bouredji
- Department of Hematology and Oncology, Antibes Juan – Les – Pins Hospital Center, Antibes, France
| | - Daniel Re
- Department of Hematology and Oncology, Antibes Juan – Les – Pins Hospital Center, Antibes, France
| | - Laurence Debono
- Department of Obstetrics and Gynecology, Antibes Juan – Les – Pins Hospital Center, Antibes, France
| | - Tony Zreik
- Department of Obstetrics and Gynecology, Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University Medical Center, Beirut, Lebanon
| | - Graziella Moufawad
- Department of Obstetrics and Gynecology, Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University Medical Center, Beirut, Lebanon
| | - Wadih Ghaname
- Department of Obstetrics and Gynecology, Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University Medical Center, Beirut, Lebanon
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Atallah D, Arab W, Dagher B, Khalil N, El Rawadi E, Atallah B, Ghaname W, El Kassis N, Chahine G, Moubarak M. Predictive factors of lymph node metastasis and pattern of repartition in patients with epithelial ovarian cancer. Future Oncol 2021; 17:5093-5101. [PMID: 34821515 DOI: 10.2217/fon-2021-0419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Aim: To determine the rate, repartition and risk factors of lymph node (LN) metastasis in patients with epithelial ovarian cancer. Methods: We reviewed retrospectively the pathological and clinical data of 184 patients with epithelial ovarian cancer at a tertiary care center in Beirut, Lebanon. Results: 88% of patients received a pelvic and para-aortic lymphadenectomy. 70% of patients presented LN metastases at both pelvic and para-aortic levels, while isolated pelvic or para-aortic LN metastases were seen in 16 and 14% of cases, respectively. In a univariate analysis, the rate of positive LNs was higher in patients with serous histology (65 vs 33%; p < 0.001), high-grade tumors (68 vs 26%; p < 0.001), bilateral adnexal involvement (74 vs 27%; p < 0.001), advanced clinical stage (p < 0.001), interval debulking surgery (63.2 vs 36.8%; p = 0.003) and positive peritoneal cytology (79 vs 26%; p < 0.001). In a multivariate analysis, the rate of LN involvement was significantly higher in patients with higher grade, advanced clinical stage and positive peritoneal cytology. Conclusion: Serous histology, grade 3 tumors, positive peritoneal cytology, advanced clinical stage, interval surgery and bilateral adnexal involvement can predict LN metastasis in patients with epithelial ovarian cancer.
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Affiliation(s)
- David Atallah
- Department of Gynecology & Obstetrics, Hôtel-Dieu de France University Hospital, Saint Joseph University, Beirut, Lebanon
| | - Wissam Arab
- Department of Gynecology & Obstetrics, Hôtel-Dieu de France University Hospital, Saint Joseph University, Beirut, Lebanon
| | - Bruno Dagher
- Department of Gynecology & Obstetrics, Hôtel-Dieu de France University Hospital, Saint Joseph University, Beirut, Lebanon
| | - Nour Khalil
- Department of Urology, Hôtel-Dieu de France University Hospital, Saint Joseph University, Beirut, Lebanon
| | - Elsa El Rawadi
- Department of Medical Oncology, Hôtel-Dieu de France University Hospital, Saint Joseph University, Beirut, Lebanon
| | - Bachir Atallah
- Department of Statistics, Clinical Research Center, Saint Joseph University, Beirut, Lebanon
| | - Wadih Ghaname
- Department of Obstetrics & Gynecology, Notre Dame de Secours Hospital, Lebanese American University, Jbeil, Lebanon
| | - Nadine El Kassis
- Department of Gynecology & Obstetrics, Hôtel-Dieu de France University Hospital, Saint Joseph University, Beirut, Lebanon
| | - Georges Chahine
- Department of Medical Oncology, Hôtel-Dieu de France University Hospital, Saint Joseph University, Beirut, Lebanon
| | - Malak Moubarak
- Department of Gynecology & Obstetrics, Hôtel-Dieu de France University Hospital, Saint Joseph University, Beirut, Lebanon
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Fayad F, Ziade N, Karam GA, Ghaname W, Khamashta M. Rheumatic diseases and pregnancy: a national survey about practice patterns among rheumatologists and obstetricians. Clin Exp Rheumatol 2018; 36:1014-1021. [PMID: 29846160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 03/05/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES Management of rheumatic diseases (RD) is often problematic in pregnant patients, hence the need for guideline implementation. This survey-based study aimed to assess beliefs among obstetricians and rheumatologists about managing RD in pregnant Lebanese patients. METHODS Questionnaires were completed by a representative sample of rheumatologists and obstetricians practicing throughout Lebanon. Collected data included physicians' information, opinion on pregnancy in RD patients, compatible drugs with fertility, pregnancy and breastfeeding, references used in their clinical management, referral to specialists, and knowledge about guidelines. Qualitative variables were analysed using Chi-square or Fisher's exact tests, and quantitative variables using Wilcoxon or Student t-tests. Results were matched against a scoring system based on the EULAR/BSR guidelines. p-value <0.05 indicated statistical significance. RESULTS Analysis showed high response rates of physicians, especially among rheumatologists. Overall, physicians practice was in concordance with international guidelines and only few misconceptions were reported. Systemic lupus erythematosus (SLE) was associated with risk on fertility, foetal malformation and eclampsia while anti-phospholipid (APL) syndrome was associated with miscarriage and vasculitis with eclampsia. Spondyloarthritis was considered 'safe' in pregnancy. Most physicians think that cyclophosphamide, leflunomide, methotrexate, mycophenolate mofetil and azathioprine compromise fertility, pregnancy, and breastfeeding. CONCLUSIONS Our data showed relatively good concordance of the physicians' beliefs with the current literature and recommendations. However, we identified misconceptions about anti-rheumatic drugs safety in pregnancy and discrepancy between rheumatologists and obstetricians practices; hence the need for promoting collaboration between both specialties and disseminating knowledge to physicians and patients in the Middle East region.
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Affiliation(s)
- Fouad Fayad
- Department of Rheumatology, Hôtel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon.
| | - Nelly Ziade
- Department of Rheumatology, Hôtel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | - Ghada Abi Karam
- Department of Rheumatology, Hôtel Dieu de France Hospital, and Saint Joseph University, Beirut, Lebanon
| | - Wadih Ghaname
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Holy Spirit University of Kaslik, Lebanon
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Atallah D, El Kassis N, Salameh C, Safi J, Bejjani L, Lutfallah F, Ghaname W, Moukarzel M. PREGNANCY AND RENAL TRANSPLANTATION. ACTA ACUST UNITED AC 2015; 63:131-7. [PMID: 26591192 DOI: 10.12816/0015835] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Pregnancy is common nowadays in kidney transplant female patients because of medical and surgical advances. However, pregnancy is a high risk one in these patients. Fertility is rapidly restored after the transplantation; thus, contraception is a good option in the first year. Adding to that, pregnancy can endanger the allograft function in the presence of hypertension, a moderate to severe kidney disease and proteinuria. Medical complications are more prevalent in kidney transplant population, such as infections, gestational hypertension and diabetes and anemia. Low birth weight infants and premature delivery are two other major concerns in this population. Acute rejection of the allograft is another major complication that can be avoided with close monitoring of the graft and convenient immunosuppression. Immunosuppressive drugs must be continued during pregnancy except for mycophenolic acid and sirolimus that can be teratogen. Delivery of kidney transplant patients should be vaginal and spontaneous. Cesarean section should be reserved for obstetrical indications. Prophylactic antibiotics should be administered for every invasive procedure. Patients treated with corticosteroids can breastfeed their babies. Kidney donating women can have a safe pregnancy but with a slight risk of gestational diabetes and hypertension. In summary, a multidisciplinary medical team should follow pregnant kidney transplant patients in a tertiary center. International and national registries are a must to collect data concerning this particular high-risk population in order to solve unanswered questions.
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Atallah D, Salameh C, El Kassis N, Safi J, Lutfallah F, Bejjani L, Ghaname W, Moukarzel M. [Infertility and kidney transplantation]. J Med Liban 2015; 63:138-143. [PMID: 26591193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Renal failure impairs the endocrine system, especially in women, due to hyperprolactinemia, altering fertility, ovulatory cycles, libido and growth in adolescents. Renal transplantation is considered the best solution to the problems of renal failure and and of dialysis, as evidenced by comparing the rate of hyperprolactinemia (100% in chronic renal failure, 60% in patients on dialysis and 35% in post-transplantation). Kidney transplant is less efficient for restoring perfect function of the hypothalamic-pituitary-gonadal axis due in part to the immunosuppressant regimens prescribed. When these drugs are properly managed, transplantation will restore near normal sexual function.
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El Kassis N, Atallah D, Moukarzel M, Ghaname W, Chalouhy C, Suidan J, Villet R, Salet-Lizee D. Surgical management of pelvic organ prolapse in women: how to choose the best approach. ACTA ACUST UNITED AC 2013; 61:36-47. [PMID: 24260839 DOI: 10.12816/0000399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Although benign, pelvic organ prolapse is a real public health problem, affecting mostly women above sixty-five. Eighty-year-old women have an 11.1% lifetime risk of undergoing surgery for prolapse or stress urinary incontinence and 29% will need a second procedure. Surgical approach may be abdominal (sacrocolpopexy by laparotomy, laparoscopy or robot-assisted) or vaginal (autologous, or prosthetic reinforcement). In addition to anatomical correction, surgical objectives include: improvement of the patient's quality of life, prolapse symptoms relief, normal urinary, digestive and sexual functions and especially, avoiding iatrogenic sequelae. Thus, the choice of the surgical approach does not only depend upon the site and the severity of the prolapse. Urogynecological surgeons should take into consideration the patient's expectations and life style, her age--a determinant factor in deciding upon the best approach -, and her relapse risk factors. They should master both approaches, and the management of surgical complications. Therefore, an apprenticeship in a reference pelviperineology center is a must. In addition, surgeons should be aware of and consider contraindications to each procedure, for instance contraindications to transvaginal prosthesis reinforcement like risk factors of bad healing or infection. Urogynecology specialists have to take into consideration known anatomical and functional results of each technique as cited in the medical literature and act in accordance with international recommendations. The surgery's main objective is to ameliorate the patient's discomfort and her quality of life without causing iatrogenic dysfunctional symptoms (urinary, digestive, sexual). The pelvic organ prolapse being a benign pathology, the patient's satisfaction is the main marker of the procedure success. In short, regarding the surgical management of pelvic organ prolapse in women the answer to the question How to choose the best approach? is not binary. It depends on several factors, and regardless of the choice, it must
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Affiliation(s)
- Nadine El Kassis
- Visceral & Gynecological Surgery Dept., Groupe hospitalier Diaconesses Croix Saint-Simon, Paris, France.
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Atallah D, El Kassis N, Moukarzel M, Ghaname W, Suidan J, Chalouhy C, Gadonneix P, Villet R. [From the open approach to laparoscopy. Background, rationale, technique]. ACTA ACUST UNITED AC 2013; 61:55-60. [PMID: 24260841 DOI: 10.12816/0000401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Genital prolapse is a frequent functional pathology in women. Its surgical treatment depends specially upon the suspension and fixation of the vaginal vault. Thus, sacrocolpopexy has become a gold standard technique to correct genital prolapse. Laparoscopy is a procedure resulting in less bleeding and decreased hospital stay than open sacrocolpopexy and is presently the approach of choice. Its objective and subjective correction rates are > 90%. Some authors proposed a dual abdominal and perineal approach to help fixing the posterior mesh and repairing the perineal body. Robotics is the actual surgeons' gadget.Its results are similar to laparoscopic sacrocolpopexy albeit a higher cost and a longer operating time. The ideal mesh is monofilamentous with large pores. Sacrocolpopexy consists in fixing two meshes, one on the anterior vaginal wall and one on the posterior vaginal wall, on the anterior sacral ligament, without tension for the posterior mesh, with or without subtotal hysterectomy, and with closure of the peritoneum at the end. In the case of associated stress urinary incontinence, proved on the clinical exam or urodynamical exam, appropriate surgical treatment is done with sacrocolpopexy. In the near future, robotics will replace laparoscopy when costs will be reduced and medical staff well trained to perform robotic or robot-assisted sacrocolpopexy.
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Affiliation(s)
- David Atallah
- Service de gynécologie-obstétrique, CHU Hôtel-Dieu de France, Université Saint-Joseph, Faculté de médecine, Beyrouth, Liban.
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